Provider Demographics
NPI:1932154085
Name:DELA CRUZ, AIDEEN KWAN (PT)
Entity Type:Individual
Prefix:
First Name:AIDEEN
Middle Name:KWAN
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AIDEEN
Other - Middle Name:TAN
Other - Last Name:KWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1528 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5559
Mailing Address - Country:US
Mailing Address - Phone:917-957-3344
Mailing Address - Fax:718-794-5117
Practice Address - Street 1:1528 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5559
Practice Address - Country:US
Practice Address - Phone:917-957-3344
Practice Address - Fax:718-794-5117
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026520225100000X, 2251P0200X, 2251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports